Postexposure Prophylaxis for Hepatitis A: What’s the Preferred Approach?

Both hepatitis A vaccine and immune globulin (IG) have been shown to be effective as postexposure prophylaxis for hepatitis A, but the two strategies have not been directly compared in a randomized, controlled trial. In a blinded, noninferiority trial, researchers in Kazakhstan randomized 1090 nonimmune close contacts (age range, 2–40 years) of persons with hepatitis A to receive one dose of either IG or hepatitis A vaccine within 2 weeks of exposure. The trial was partially funded by the vaccine manufacturer.

Only 4.4% of vaccine recipients and 3.3% of IG recipients developed confirmed symptomatic infection with hepatitis A (relative risk among vaccine recipients, 1.35; 95% confidence interval, 0.7–2.7). Some measures (e.g., degree of jaund…